Healthcare Provider Details

I. General information

NPI: 1326109190
Provider Name (Legal Business Name): MARVIN PEREZ PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 HERNDON AVE
CLOVIS CA
93611-6101
US

IV. Provider business mailing address

2071 HERDON AVENUE
CLOVIS CA
93611-0361
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-5574
  • Fax: 559-324-5575
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: